NPI | 1134355175 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2009012055) |
Enumeration Date | 2009-06-04 |
Last Update Date | 2021-10-14 |